More than half of the people fatally shot by San Francisco Police Department (SFPD) officers within a nine-year period suffered from some form of mental illness, according to data released by public broadcaster KQED on Tuesday.

The data found that, of 19 people fatally shot by officers, 11 had mental health issues that were a contributing factor in police encounters between 2005 and 2013. This year alone, seven people suffering from a psychiatric episode have been killed by officers, according to KQED.

The report adds to an ongoing national conversation about how police in major metropolitan areas are trained — or, in most cases, not trained — to respond to those suffering from mental illness.

Earlier this year, the Albuquerque Police Department was slammed by the U.S. Department of Justice (DOJ) for being too trigger-happy when it came to responding to incidents involving mentally unstable subjects. The review, which was released in April, came after police were criticized for their handling of an encounter involving 38-year-old James Boyd, who had been camping in New Mexico’s Sandia Mountains when he was approached, and later shot, by Albuquerque police.

The DOJ review found that Albuquerque police were inadequately trained to handle interactions with those who suffer from mental illness. The review stated that the police department’s “policies, training, and supervision are insufficient to ensure that officers encountering people with mental illness or in distress do so in a manner that respects their rights and is safe for all involved.”

Other police departments have made an attempt to step up their policies and training with respect to encounters involving people experiencing psychotic episodes and those who suffer from mental illness. According to KQED, several law enforcement agencies in Northern California have adopted mental illness training that was created by the Memphis Police Department after officers there fatally shot a mentally-unstable man in 1988.

The so-called “Memphis Model” has been adopted by the Oakland Police Department as part of its Crisis Intervention Training (CIT) program. Officers there spend six hours learning how to interact with mentally ill individuals, including what warning signs to look for when assessing whether a person may be suffering from a psychotic episode.

“Officers in CIT class learn that nonverbal cues — like speaking in a soft voice, slowing down and resting a hand at one’s side instead of on one’s gun — are likely more important that what they’re saying,” KQED’s Alex Emslie and Rachael Bale report. “The reason has to do with the hierarchy of the human brain.”

SFPD adopted the Memphis Model as part of the agency’s CIT training in 2011. But three years later, very few officers have undergone the training, leaving dozens on the force woefully unprepared to handle subjects with mental illness.

According to KQED, just 18 percent of SFPD officers are CIT-trained. Part of the reason is because few officers seem willing to undergo training — KQED reports that “few officers volunteered” for CIT training — which means the burden of deciding who to send to training often falls with the station chiefs.

Worse, when CIT training began three years ago, the idea of preparing officers to deal with mentally incapacitated individuals “wasn’t fully supported inside the department … so few officers were trained.” Those who were trained sometimes weren’t dispatched to calls involving those suffering from psychotic episodes because “there was also no official way to dispatch CIT officers to a scene.”

That changed, but only recently, when SFPD Chief Greg Suhr issued a directive in April ordering 9-1-1 dispatchers to acknowledge CIT-related emergency calls.

Despite the slow rollout, the program seems to be working. According to internal data cited by KQED, the number of police killings involving mentally ill individuals is now on par with the national average. But there’s still more work to be done — something that SFPD acknowledges.